Missed opportunity for cervical cancer screening among women aged 25-49 years attending maternal and child health services clinic at Masaka Regional Referral Hospital.

Abstract

Background: Cervical cancer is the fourth most frequent and fatal cancer among women globally, and the most incident and fatal cancer in Uganda. Integration of cervical cancer screening into Maternal and Child Health (MCH) clinic at Masaka Regional Referral Hospital (MRRH) is one of the strategies for early detection and treatment of precancerous cervical cells, but uptake remains low, and many women continue to go through the clinic unscreened. Objective: To determine the prevalence and factors associated with missed opportunity for cervical cancer screening among women attending MCH clinic, as well as identify health system challenges in delivery of integrated cervical cancer screening services at MRRH. Methods: This was a facility-based cross-sectional study that was conducted at MRRH, MCH clinic in Masaka district. The prevalence and factors associated with missed opportunity for cervical cancer screening were determined among 424 eligible women. These were consecutively sampled after receiving services at the MCH clinic and were interviewed using a paper-based structured questionnaire. Quantitative data were descriptively analyzed to determine the prevalence of missed opportunity for cervical cancer screening, and bivariate and multivariable analyses were conducted to determine factors independently associated with missed opportunity using a modified Poisson regression model. Health system challenges were identified qualitatively using key informant and in-depth interviews among (8) purposively selected key informants and (3) women who screened from the MCH clinic respectively, and the data were analyzed manually using content analysis. Results: The prevalence of missed opportunity for cervical cancer screening was 96.9%, and the factors that were significantly associated with missed opportunity for cervical cancer screening were: not being told about cervical cancer screening or the availability of the service (adjusted prevalence ratio [adj.PR] =1.12; 95% confidence interval [95%CI]: 1.05, 1.18), being single (adj.PR=1.02; 95%CI: 1.01, 1.04), and having 6-8 children (adj.PR=1.04; 95%CI: 1.01, 1.08). The main challenges in delivery of cervical cancer screening were: limited human resources, inadequate technical capacity to screen for cervical cancer, client overload and limited spacing. Conclusion: Despite integration of cervical cancer screening into MCH services, nearly all women interviewed had a missed opportunity for cervical cancer screening. This could be due to xi the identified health system challenges of: limited human resources, inadequate technical capacity to screen for cervical cancer, client overload and limited spacing. These findings call for health managers and policy makers to plan for and address the health system challenges related to services integration in order to improve utilization of the services.